Treatment and Prevention
The first priority is to relieve pain and shorten the acute attack. NSAIDs (nonsteroidal anti-inflammatory drugs) such as naproxen are the mainstay of treatment. These medications help with the swelling and pain. Another medication called colchicine can lessen joint pain, but it can cause diarrhea so it is not usually used for acute treatment. Corticosteroids, either injected directly into the joint or taken orally, are the most effective way to quickly control inflammation and to abort the attack.
For non-acute treatment, colchicine reduces the process of inflammation but does not change the production of uric acid. Taking colchicine once or twice daily will usually significantly reduce the frequency of attacks, but it does not prevent joint damage caused by tophi. While most people tolerate it well, some experience side effects.
Someone who gets a gout attack once or twice a year and does not have kidney stones or high urine levels of uric acid usually does not need chronic treatment. When attacks are more frequent or kidney damage is a risk, then medications to reduce uric acid levels are appropriate, but they have to be taken continuously, usually for the rest of the person's life.
There are two types of medications that reduce uric acid levels. The first type is called a uricosuric agent, such as probenecid, and sulfinpyrazone. They work by increasing the excretion of uric acid in the urine. However, they are not useful if the urine uric acid level is already high. The other type is called xanthine oxidase inhibitor, such as allopurinol and febuxostat. These work by reducing the production of uric acid, thus reducing blood and urine levels. These medications are never started during an acute attack.
When blood uric acid is reduced, stored uric acid come out of storage into the bloodstream. This change stimulates new gout attacks, so that for up to 6 months after starting medications such as allopurinol, patients may experience increased frequency of attacks. Fortunately, taking colchicine once or twice daily for a long time can reduce those extra attacks considerably.
Another medication called pegloticase is available to treat gout. It works by dissolving uric acid and can rapidly reduce tophi. Unlike the other medications, pegloticase is given intravenously (injected into the vein).
Prevention is an important part of managing gout. It is crucial to control weight and blood pressure and be well-hydrated. A healthy diet is very important, as is maintaining a healthy weight with minimal visceral fat. There are diets specific to reducing uric acid, which involves eating foods that are low in purines and pyramidines. These diets can be impractical to follow and have only a small effect. However, avoiding organ meats such as liver, kidney, heart, gizzard, and sweetbreads can help reduce the risk of a gout attack.
Anything more than moderate alcohol intake has the potential for triggering a gout attack. If you drink alcohol, keep it to only one glass of wine or beer in a 24-hour period.
With early diagnosis and treatment, it's possible to control gout, prevent joint damage, and live a normal life.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.